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Refractory Status Epilepticus in Suspect Encephalitis

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Abstract

Background

The California Encephalitis Project (CEP) is a program designed to determine causes of encephalitis. We sought to determine whether there are any distinguishing characteristics of patients with encephalitis who develop refractory status epilepticus from those who do not.

Methods

Data from all patients in the CEP were retrospectively reviewed and analyzed. Diagnostic testing was performed for a panel of infectious agents and medical information collected using a standardized form. Encephalitis patients were subdivided into three categories: (i) patients with status epilepticus unresponsive to standard antiepileptic therapy who required general anesthetic coma for management (Group I), (ii) patients with seizures or status epilepticus responsive to standard antiepileptic therapy (Group II), and (iii) patients without seizures (Group III). Supplementary information was requested on Group I patients.

Results

Of 1,151 patients; 43 (4%) were classified as Group I, 459 (40%) as Group II, and 649 (56%) as Group III. Compared to Groups II and III, Group I patients were younger (median age = 10.0 years), more likely to have fever (93%), prodromal respiratory (57%) or gastrointestinal illness (64%), and less likely to have CSF pleocytosis (47%) or abnormal neuroimaging (16%). A causative infectious agent was verified in three of the Group I patients; and a putative agent in nine others. Supplementary information on Group I revealed that 28% died within 2 years and 56% were neurologically impaired or undergoing rehabilitation.

Conclusions

Encephalitis and refractory status epilepticus occur most commonly in the pediatric age group, an infectious etiology is usually not established, and outcomes are generally poor.

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Acknowledgments

We thank the clinicians who referred patients to the CEP. We thank Fred Schuster, David Schnurr, Karen Bloch, and Lisa Bateman for their careful review of the manuscript. We also gratefully acknowledge the laboratory staff in the CDHS VRDL and Microbial Disease Laboratory for performing the diagnostic testing. We confirm that we have read the journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Financial support: Centers for Disease Control and Prevention Emerging Infections Program (U50/CCU915546–10). M. Solbrig is supported by the National Institute of Neurological Disorders and Stroke (NINDS) grant NS042307 and D. Lowenstein by NINDS grants NS053998, NS056975, and U54RR023566.

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Authors and Affiliations

  1. Viral and Rickettsial Disease Branch, California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA, 94804, USA

    Carol A. Glaser, Sabrina Gilliam & Somayeh Honarmand

  2. Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA

    Jay H. Tureen

  3. Department of Neurology, University of California, San Francisco, San Francisco, CA, USA

    Daniel H. Lowenstein

  4. Respiratory and Enteric Viruses Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Larry J. Anderson

  5. Department of Pathology, University of California, San Francisco, San Francisco, CA, USA

    Andrew W. Bollen

  6. Department of Neurology, University of California, Irvine, CA, USA

    Marylou V. Solbrig

Authors
  1. Carol A. Glaser
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  2. Sabrina Gilliam
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  3. Somayeh Honarmand
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  4. Jay H. Tureen
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  5. Daniel H. Lowenstein
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  6. Larry J. Anderson
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  7. Andrew W. Bollen
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  8. Marylou V. Solbrig
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Corresponding author

Correspondence to Carol A. Glaser.

Appendix A: California Encephalitis Project Case History Form

Appendix A: California Encephalitis Project Case History Form

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Glaser, C.A., Gilliam, S., Honarmand, S. et al. Refractory Status Epilepticus in Suspect Encephalitis. Neurocrit Care 9, 74–82 (2008). https://doi.org/10.1007/s12028-007-9042-y

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  • DOI: https://doi.org/10.1007/s12028-007-9042-y

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